Does Medicare Part B Cover Blood Pressure Monitors?

Medicare Part B provides coverage for a range of medical services and supplies, including certain types of durable medical equipment (DME). Durable medical equipment encompasses items that are designed for repeated use, serve a medical purpose, and are appropriate for use in a home setting. This equipment typically withstands repeated use and is expected to last at least three years.

General Coverage Under Part B

Medicare Part B generally covers durable medical equipment (DME) when it is medically necessary and prescribed by a Medicare-enrolled doctor or other healthcare provider for use in your home. Durable medical equipment helps manage a health condition, recover from an injury or illness, or assist in post-surgical recovery.

While many types of DME are covered, specific rules apply to blood pressure monitors. Original Medicare (Parts A and B) typically does not cover standard at-home blood pressure cuffs. Medicare Part B may cover an Ambulatory Blood Pressure Monitor (ABPM) under specific conditions.

Specific Coverage Requirements

For Medicare Part B to cover an Ambulatory Blood Pressure Monitor (ABPM), specific conditions must be met. A physician or other healthcare provider must determine and document that the ABPM is medically necessary for diagnosing or managing a medical condition. This typically involves situations where traditional office blood pressure readings are insufficient or misleading.

Coverage for an ABPM is usually provided once a year if a doctor suspects “white coat hypertension” or “masked hypertension.” White coat hypertension occurs when blood pressure is elevated in a clinical setting but normal outside of it, while masked hypertension involves normal office readings but elevated readings elsewhere. A valid written order or prescription from the treating physician is required, specifying the medical necessity for the device. Furthermore, the monitor must be obtained from a supplier enrolled in Medicare, ensuring they meet federal standards for providing DME.

How to Obtain a Covered Monitor

Once a physician has determined the medical necessity for an Ambulatory Blood Pressure Monitor (ABPM) and provided a written order, the next step involves working with a Medicare-enrolled supplier. You can ask your physician for recommendations for Medicare-enrolled suppliers or search the Medicare website for approved providers in your area.

It is important to confirm that the chosen supplier is enrolled in Medicare and accepts Medicare assignment. Suppliers who accept assignment agree to accept the Medicare-approved amount as full payment for the equipment. This agreement helps to limit your out-of-pocket costs. The supplier will then process the order, verify your coverage, and arrange for the ABPM, which is often rented for the monitoring period.

Understanding Your Out-of-Pocket Expenses

Even when a blood pressure monitor is covered by Medicare Part B, beneficiaries typically incur certain out-of-pocket expenses. The annual Part B deductible must be satisfied before Medicare begins to pay its share. After this deductible is met, Medicare usually covers 80% of the Medicare-approved amount for the durable medical equipment.

The remaining 20% of the Medicare-approved amount is your responsibility as coinsurance. For instance, if the Medicare-approved amount for an ABPM is $100 and you have met your deductible, Medicare would pay $80, and you would be responsible for $20. Choosing a supplier that accepts Medicare assignment is important because they cannot charge you more than the Medicare-approved amount, protecting you from higher costs.